In response to the West Virginia Attorney General’s invitation for public comment on the issue, VCA has requested that the state immediately initiate the process to enact common-sense health and safety regulations for abortion clinics. Reproduced here is the letter, in its entirety:
Dear Attorney General Morrisey,
On behalf of Virginia Christian Alliance (VCA) and the Valley Family Forum , I request that you use the powers of your office to initiate the process for enactment of common-sense health and safety regulations for West Virginia abortion clinics. It is beyond question that the state has both the authority and the duty to regulate these facilities. Abortion centers obviously affect the physical health of the women and girls who seek their services, but their operations are also a testimony to the level of our society’s regard for human life and the gravity with which we imbue the practice of purposefully ending it.
In this letter, we will discuss: (1) Why state oversight and regulation of abortion clinics (including reporting requirements) are needed; (2) Why these facilities may and should be regulated more stringently than other medical centers; and (3) Why arguments against regulation are unpersuasive.
Abortion is a serious, often invasive medical procedure, but complication risks have been obscured.
Known potential complications of abortion include permanent damage to reproductive and other vital organs, dysfunction of the cardiovascular or respiratory system, internal bleeding or hemorrhaging, embolism, and allergic reactions. In addition to the more immediate complications of abortion, voluminous studies prove that abortion carries many long-term health risks.
Yet, because of the lack of standard reporting requirements within states and nationwide, it is impossible to accurately assess the frequency with which these and other serious abortion complications actually occur. For instance, the Center for Disease Control (CDC) reported that seven women died from complications of legalized abortions in 2005. Yet the CDC report explicitly recognized that its data are compromised due to a known, significant under-reporting of the number of abortions performed nationwide. The CDC report contained no information regarding abortion complications other than death, as this information is apparently not reported or collected in many states.
In a recent article that appeared in the Washington Post, reporters cited statistics from the CDC to demonstrate the alleged safety of abortion. According to CDC numbers, 10 women died from abortions in 2010, compared with 793 deaths from bicycle accidents. The comparison is misleading and irresponsible because, in the case of CDC abortion statistics, the numbers that tell the real story are the numbers that aren’t there. Even states that require abortion reporting do not require reporting to the CDC. The Alan Guttmacher Institute has estimated that the voluntarily reported information excludes data on as many as 45-50% of annual abortions.
Awareness of this “missing data” problem seems to be growing. For instance, a 2011 Chicago Tribune story by Megan Twohey flagged the disparity between the number of Illinois abortion providers that reported required data to state officials (26) and the number of providers actually in business (37). The article also suggested that the state’s data failed to account for as many as 17,000 abortions annually. While we know that the risks abortion poses to women’s health are many and serious, it is likely that additional regulations, including certain reporting requirements, would help us to understand them better.
The nature of the abortion procedure and its inherent risks are reason enough to advocate for increased regulation of abortion clinics. Indeed, even proponents of abortion rights have historically professed a commitment to ensuring that abortion is “safe, legal, and rare.” The fact is that as long as abortion remains legal, the state has a public duty to ensure that it is at least “safe” for the women who choose it. If legalized abortion is to continue, the state must see that abortion clinics do not themselves become the dreaded “back-alleys.”
Abortion is inherently different than other medical procedures and warrants stringent regulation.
Women and girls who undergo abortions deserve at least the same level of regulatory oversight as that in place for patients generally in other settings where serious medical procedures are performed. But both the United States Supreme Court and lower federal courts have found that the peculiar nature of abortion justifies standards that are more stringent than those imposed on other medical facilities. The Supreme Court has noted that “abortions are inherently different from other medical procedures…” This is why federal courts have repeatedly affirmed that states have a legitimate interest in regulating abortion clinics more stringently than other medical facilities. Abortion is different, the Supreme Court has found, “because no other procedure involves the purposeful termination of a potential life.”
The United States Court of Appeals for the Fourth Circuit has definitively rejected the argument that abortion clinics must be treated the same as other medical facilities in terms of health and safety regulations. In Greenville Women’s Clinic v. Bryant, the Fourth Circuit held that regulations of abortion providers need only be rationally related to a valid governmental purpose, and went on to note that “The rationality of distinguishing between abortion services and other medical services when regulating physicians or women’s healthcare has long been acknowledged by Supreme Court precedent.” The court pointed to a long line of United States Supreme Court precedent, beginning with Roe v. Wade itself, recognizing that abortion is a unique act fraught with consequences for the woman undergoing the abortion and for many others. This is why, for instance, the Supreme Court has rejected the argument that states may not impose record-keeping and informed consent requirements on abortion providers that significantly differ from those imposed on providers of arguably comparable healthcare services.
Arguments opposing regulation are unpersuasive.
VCA has been actively involved in advocating for abortion clinic regulations here in the Commonwealth of Virginia, so we are familiar with the polarized nature of this issue and the arguments that will be made by the abortion industry and its supporters throughout this process. While abortion advocates invariably attempt to frame the issue before you as a civil rights issue, the United States Supreme Court has made it very clear that state regulations aimed at protecting the safety and health of women seeking abortions do not implicate civil liberties.
Here in Virginia, the abortion industry objected most strenuously to the design and construction standards that were included in the Commonwealth’s new regulations. But as the Fourth Circuit pointed out when it upheld similar standards in Greenville Women’s Clinic, supra, national standards promulgated by groups such as the American Congress of Obstetricians and Gynecologists, the National Abortion Federation, and Planned Parenthood already include standards for the centers’ physical facilities, including requirements that examining rooms contain sterilization facilities; alarm systems be in place; procedure rooms be large enough to accommodate a stretcher or gurney; post-procedure recovery rooms and dressing rooms be available; operating tables be located in rooms of adequate dimensions, illumination, and ventilation; procedure rooms have doors wide enough to accommodate a stretcher or wheelchair, etc. Thus, to the extent that existing facilities within your state are resistant to their being required to comply with regulations substantially similar or identical to these professional guidelines, state officials should be deeply concerned about the adequacy of current conditions in these facilities.
Another argument typically raised by abortion advocates is that health and safety regulations will make abortion prohibitively expensive for some women. However, the actual evidence proffered by abortion clinics that challenged the South Carolina regulations indicated that the estimated increase in cost to their patients would range from only $23-$75 per abortion. This is comparable to the cost of dinner and a movie for two. It is a small price to pay for enhancing the safety of a procedure that carries significant medical risks and is qualitatively different from any other.
Conclusion
Your office is certain to be flooded by impassioned pleas or threats of lawsuits by those who benefit financially from a lenient regulatory environment that endangers women’s health and safety and desensitizes society to the tragedy of abortion. Virginia Christian Alliance and the Valley Family Forum implore you to act in the best interest of public health, safety, and morality rather than cede to the demands of those motivated by political or financial interests.
I hope this information has been helpful. If you have any questions or if I can provide further assistance, please feel free to contact me at (540) 830-1229 or rita@vachristian.org.
Sincerely, Rita M. Dunaway,
Vice President for Public Policy Virginia Christian Alliance
Rita M. Dunaway graduated summa cum laude from West Virginia University in 1998, having earned a B.S. in Journalism and a B.A. in Political Science simultaneously. She then attended law school at Washington and Lee University School of Law, graduating cum laude in 2001.
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1 VCA is a non-profit organization which seeks to impact Virginia through well-reasoned, respectful advocacy and education on public policy issues and by challenging Christians to engage the culture and serve their communities.
2 The Valley Family Forum, comprised of citizens in the Shenandoah Valley which borders West Virginia, works to inform and mobilize the Valley in support of public policies that promote faith, family and freedom.
3 See A Woman’s Choice – East Side Women’s Clinic v. Newman, 305 F.3d 684, 702 (7th Cir. 2002)(Coffey, C.J., concurring).
4 See, e.g., J. S. Brown, Jr., T. Adera, S. W. Masho, “Previous abortion and the risk of low birth weight and preterm births,” Journal of Epidemiology and Community Health (Vol. 62, Issue 1).
5 Center for Disease Control, “Abortion Surveillance – United States, 2006,” Morbidity and Morality Weekly Report, available at http://www.cdc.gov/mmwr/PDF/ss/ss5808.pdf.
6 Id.
7 Harris v. McRae, 448 U.S. 297, 325 (1980).
8 Id.
9 Greenville Women’s Clinic v. Bryant, 222 F.3d 157 (4th Cir. 2000), cert. denied, 531 U.S. 1131 (2001).
10 Id. at 173.
11 Id.
12 Id. (quoting Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 80-81 (1976)).
13 See, e.g., Planned Parenthood of Southeastern Pennsylvania v. Casey, 505 U.S. 833, 878 (1992) (“As with any medical procedure, the State may enact regulations to further the health or safety of a woman seeking an abortion.”); Roe v. Wade, 410 U.S. 113, 150 (1973) (recognizing legitimate state interest in seeing that abortion is performed under circumstances that maximize patient safety); Greenville Women’s Clinic v. Bryant, 222 F.3d 157 (4th Cir. 2000) (reversing lower court’s holding that clinic safety regulations were unconstitutional), cert. denied 531 U.S. 1131 (2001).
14 222 F.3d at 168.
15 Id, at 170.
